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Support Path Patient Assistance Program
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Phone
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(855)769-7284
Fax:
(855)298-8700
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Eligibility
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Must be uninsured and be ineligible for federal or state programs; or have a plan design limitation. Medicare Part D patients are not eligible for this program. Income must be a or below 500% of FPL* (see below). Must reside permanently in the US or US territories. |
| Who Can Apply
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Call to have application faxed, mailed or download from website. Return application via fax or mail. A decision will be received by phone or mail in 2 business days, once application process is complete. |
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Required
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Diagnosis/Medical Criteria *See Additional Information section below. Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information. |
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Supply
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Up to a 28 day supply. Company contacts patient to arrange refills. 2 enrollments per lifetime. Re-application process determined case by case. |
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Ship To
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Ship to Doctor's office or patient's home within 2-3 business days. |
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Note
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*500% FPL or less than $100k for the household
This program also provides copay assistance.
Patient must be diagnosed with Chronic Hepatitis C. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Harvoni tablet |
| Sovaldi tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Support Path Patient Assistance Program |
(Requires Acrobat Reader) 
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